Splitting boluses - help

[lauraw1983]

Ok after a bit of advice please - can you tell me how you guys split boluses for high fat/carb meals?

It's the one area I just cannot get right!!

Last night we had Indian - not takeaway, from the supermarket but I had quite a lot of rice and a small naan bread! I normally just have one or the other but last night was an exception after a stressful, busy and v tiring day & I was sooo hungry.

So I was able to carb count as the nutritional info was on the packs, and thought I had got it not too bad....BG before I ate was 17.4 (don't ask, bad day!!) at 7.30pm - carb count was 100g so 10u, plus I took a 5u correction as 1u brings me down 2mmol.

I didn't split it last night as when I have tried before I just cannot get it right either, and I was trying to get an early night last night!

At 22.30 (bedtime and Levemir time) it was 9.8 so I figured with some insulin still working it'd bring me down to about 6/7ish.

This morning woke to a 15.9. ARGHHH.

Took 5u correction dose at 8am, which has brought things back down to nearer normal now, I know I can get it back on track ok but weekends/days like I have just have just make diabetes seem an even bigger PITA than it is at other times!

So tell me what has worked for you in the past?! Is it with high carb/fat meals, that they just take longer to metabolise and digest?

If it helps I think Humalog works for nearer 5 hours for me than the 4 that it's "meant" to.

 

[everydayupsanddowns]

A tricky test case to evaluate as you were a bit high to start with (not sure about you but my corrections sometimes need an extra unit or two from higher levels)

My basic MDI split for larger and higher fat meals was to add 'spare' to the bolus (as much as an extra third) and split the remaining oversized bolus 60:40 first part immediately before the meal, second part 2-3 hours later

I worked up to that point with a variety of wild guesses (and the 'adding a third' suggestion from these very boards), and 2-hourly post-meal tests through the evening into the early hours to watch when the initial bolus was wearing off and the food was still chugging. The important thing for me was to control the initial food rise and spread the activity of the insulin. Injjecting all up front from an in-range premeal reading used to make me hypo just after the meal, then rise and rise and rise later. 🙄 Splitting worked well for me for several years - though it's always a bit high risk!

I had it nailed on the pump a while ago... but have had a number of failures since so I'm tweaking again 🙂

 

[pgcity]

Its so tricky to get this right. I have been practising with pasta all week and still haven't got it sorted. My tactic before the pump was to take half the insulin up front and then the rest every hour for four hours.

Another way to tackle it is to have your carb heavy/fatty meal for lunch and test every hour to see how long it takes you to digest.

Good luck

 

[randomange]

A tricky test case to evaluate as you were a bit high to start with (not sure about you but my corrections sometimes need an extra unit or two from higher levels)

My basic MDI split for larger and higher fat meals was to add 'spare' to the bolus (as much as an extra third) and split the remaining oversized bolus 60:40 first part immediately before the meal, second part 2-3 hours later

I worked up to that point with a variety of wild guesses (and the 'adding a third' suggestion from these very boards), and 2-hourly post-meal tests through the evening into the early hours to watch when the initial bolus was wearing off and the food was still chugging. The important thing for me was to control the initial food rise and spread the activity of the insulin. Injjecting all up front from an in-range premeal reading used to make me hypo just after the meal, then rise and rise and rise later. 🙄 Splitting worked well for me for several years - though it's always a bit high risk!

I had it nailed on the pump a while ago... but have had a number of failures since so I'm tweaking again 🙂

I was almost exactly the same as Mike on MDI - add a third if carb count was 100 or greater, take 50% up front, and the other 50% 2 hours later. Worked for most things, and took a bit of trial and error to see how much I needed to inject upfront, and when to add the second injection.

You'll get there! 🙂